clinical consequences of respiratory infection Flashcards
what can be classified as a respiratory infection? 4
- URTI
- acute bronchitis
- exacerbation of chronic airway disease (COPD, bronchiectasis)
- pneumonia (CXR diagnosis in hospital, clinical in community setting)
what are the classifications of pneumonia? 6
- anatomical:
- lobar
- bronchopneumonia
- diffuse
- setting:
- community acquired
- hospital acquired
- ventilator related
describe pneumonia prevalence? 4
- more common in the very young and old
- about 25% require hospital admission
- of those admitted, around 10% need ITU care
- accounts for only 10% of all LUTI
what is the clinical assessment for pneumonia? 3
- full history (remember pets, jobs, hobbies, risk for immunocompromised, home situation, smoking)
- full examination (note RR/HR/BP/stats, are they confused?)
- signs of pneumonia: reduced air entry, bronchial breathing, increased resonance/ crackles
what are pneumonia diagnostics? 7
- blood tests: assess for evidence of infection/inflammation, assess for renal function, assess for liver function, blood cultures, HIV test
- sputum
- viral throat swab/mycoplasma
- urine (legionella)
- arterial blood gas
- CXR
- look for areas of opacification
how do we assess pneumonia severity? 6
- the CURB 65 score
-confusion
-raised blood urea (>7mmol/L) - raised respiratory rate (>30/min)
-low blood pressure (95/60)
-age >65
(if no urea, CRB score)
how do we manage pneumonia in the community? 6
- rest
- push fluids
- analgesics
- antibiotic
- safety net
- refer if there is no improvement in 48 hours
how do we manage pneumonia in hospital? 4
- oxygen if required
- fluid replacement if required
- antibiotics
- critical care management
what does the choice of antibiotics for pneumonia patients depend on? 5
- setting
- severity
- co-morbidities
- epidemiology
- patient allergies
what drugs are give in these scenarios for pneumonia?
- community
- hospital- not severe
- hospital- severe
- beta lactam (amoxicillin) or doxycycline
- amoxicillin +/- doxycycline
- amoxicillin and doxycycline or ceftriaxone/levofloxacin
what are the clearance rates after community acquired pneumonia? 2
- in adults 19-60, 95% will clear within 6 weeks
- clearance is slower with increased comorbidity
what happens to pneumonia patients in critical care? 6
- can give higher oxygen concentration, positive pressure and reduce work of breathing
- nasal HiFlow
- CPAP (continuous positive airway pressure)
- NIV (non-invasive ventilation)
- intubation and invasive ventilation
- if everything fails, consider ECMO (extracorporeal membrane oxygenation)
describe some pneumonia complications? 7
- general:
- respiratory failure
- sepsis
- multi-system failure
- local:
- pleural effusion
- empyema
- lung abscess
- organising pneumonia
what happens if there is a failure to respond to treatment in pneumonia? 5
- wrong or incomplete diagnosis
- antibiotic problem
- complication developing
- underlying bronchial obstructions
- approach-re-review
what is pleural parapneumonic effusion? 5
- to be considered when the patient is not responding to treatment
- simple parapneumonic
- complicated parapneumonic
- emphyma
- dominant microbiology is pneumococcus but also S.aureus and S.milleri
- consider differential diagnosis of pleural TB
